OCULAR MELANOMA

What is Ocular melanoma? Ocular Melanoma is a cancer (melanoma) of the eye involving the iris, ciliary body or choroid. Tumors arise from the pigment cells (melanocytes) that reside within the uvea giving color to the eye.

Uvea The Uvea is the middle layer of the eye underneath the white part of the eye (sclera). It has three parts: Iris: The colored part of the eye that opens and closes to change the amount of light that enters the eye. Ciliary Body: A muscle in the eye that changes the shape of the lens so that the eye can focus. Choroid: A layer of tissue that is in the back of the eye, next to the retina that makes a picture.

Anatomy of the eye

Signs & symptoms of ocular melanoma In early stages, ocular melanoma may not cause any symptoms because most the melanomas develop in the part of the eye you cannot see. Blurred Vision Flashing Lights Shadows Poor vision in one eye Red, painful eye Floaters (spots or squiggles drifting in the field of vision) Dark spot on the iris Sudden loss of vision Change in size or shape of the pupil

Exam Examination of the eye by an Ophthalmologist is an important step in diagnosing melanoma of the eye. Most of the time melanoma of the eye can be diagnosed with an eye exam alone. Very rarely a biopsy will be needed.

Exam Instruments Ophthalmoscope: is a hand held instrument consisting of a light and a small magnifying lens. Indirect Ophthalmoscope: and a slit lamp is like a large microscope. You sit down and rest your chin on a small platform while the doctor looks into your eye through the magnified lenses. It usually gives a more detailed view inside the eye. Gonioscopy lens: is a specially mirrored lens that is placed on the cornea (after its numbed) that allows the doctor to see the deep structures on the angle of the front of the eye that would normally be hard to see.

Imaging Imaging tests are sometimes used if the doctor feels like the eye exam suggests you might have eye cancer. Some of those tests are as follows: Ultrasound: Uses high-frequency sound waves to make a picture the eye. A small wand-like instrument is placed up against the eyelid and the sound waves are sent through the eye. The instrument picks up the pattern of echoes that come back and is converted into an image on a computer screen.

High-resolution ultrasound bio-microscopy: A procedure in which high-energy sound waves are bounced off the internal tissue of the eye to make echo’s. A small probe that sends and receives sound waves is placed gently on the surface of the eye. The echoes make a more detailed picture of the inside of the eye than a regular ultrasound. The tumor is checked for its size, shape, thickness and for signs that the tumor has spread to nearby tissue.

Fluorescein Angiography: An orange fluorescent dye is injected into the bloodstream through a vein in the arm. Pictures of the back of the eye are then taken using a special light that causes the dye to glow. This lets the doctor see the blood vessels inside the eye, and to check for any blockages or leaks. (Although melanomas do not have a special appearance with this test, some other eye problems do).

Tests After melanoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. The following tests and procedures may be used: Blood Chemistry Studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the body by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that make it.

Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign the cancer has spread to the liver. Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the liver and make echoes. The echoes form a picture of body tissues called a sonogram.

Chest x-ray: An x-ray of the organs and bones inside the chest Chest x-ray: An x-ray of the organs and bones inside the chest. An x- ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. MRI: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. CT Scan: A procedure that makes a series of detailed pictures of areas inside the body such as the chest, abdomen, or pelvis taken from different angles. The pictures are made by a computer linked to an x-ray machine.

Staging There are different ways to stage Ocular melanoma. TNM system: which looks at the tumor size (T), whether the cancer has spread into lymph nodes (N) and whether it has spread to other parts (M- metastasised). OM rarely spreads the lymph system, its more likely to spread through the blood. Simple staging: Small: the melanoma is between 1mm and 2.5mm thick and up to 5mm wide. Medium: the melanoma is between 2.5 and 10mm thick, and between 5mm and 16mm wide Large: the melanoma is more than 10mm thick or more than 16mm wide.

Ocular melanoma

Ocular Melanoma

Treatment Depending on the size of the tumor, location and if the cancer has spread, some of the treatment options are listed below: Watchful waiting (if tumor is small or slow growing) Surgery (removal of tumor and surrounding tissue) Plaque radiation therapy ( thin piece of metal with radioactive seeds on one side is sewn onto the outside wall of the eye with seeds aimed at the tumor. Removed at end of treatment (several days).

Treatment Charged particle external beam therapy(uses a particle accelerator to fire high-energy particles such as protons that kill cancer cells. Enucleation (the removal of the eye) and implant attached Cryotherapy (general use of low temperatures)

Follow-up Have regular check-ups (every 6 months) Blood tests X-rays or scans Eye examinations Report any new symptoms or concerns